smart thinking about sex, intimacy, and life in a body

SEXUAL HEALTH: sensible talk about herpes

Researching medical conditions online is always a dicey proposition. Dr. Google almost always offers too much information (e.g., statistics without context), focuses on worst-case scenarios, and scares people to death, sometimes intentionally. All of that is especially true when it comes to the subject of herpes. “I have seen herpes make more people cry than a positive hepatitis-C result,” says my friend Brett, a veteran sex educator who recently graduated from nursing school. “Doctors really do the world dirty by how they present this.”

I have had conversations with numerous clients who were concerned (“freaking out” is not too strong an expression) to learn they themselves have herpes or that a partner has herpes, based on either a blood test coming back positive or experiencing an outbreak of herpes lesions. Because it is true that once you’ve acquired the herpes virus it stays in your nervous system forever and that herpes is sometimes transmitted through sexual contact, it’s not uncommon for someone in the throes of freaking out to leap to the conclusion that “OMG my boyfriend has given me an incurable disease and/or I can never have sex again!” Neither of those statements is accurate. Active herpes infections are something to take seriously, and of course conscientious people make every effort not to pass sexually transmitted infections on to their sex partners. But herpes is treatable, not tragic. I would like to take this opportunity to offer some calm practical information about the realities of living with herpes.

What we’re talking about is the herpes simplex virus, of which there are two types, HSV I and HSV II. HSV I affects the mouth and face and causes crusty cold sores on the lips or chancre sores inside the mouth. Almost everyone has HSV I; it’s usually acquired as an upper respiratory infection during early childhood. HSV II causes genital herpes, which can manifest as small clusters of itchy blisters on the penis, vulva, or anus. “There is some evidence of crossing over (HSV I causing genital herpes and HSV II causing oral herpes),” says Brett, “but the numbers don’t support the freakout.”

Guys usually learn they have herpes when they find tiny blisters on their dicks that turn into painful sores. It can take a couple of weeks for the sores to run their full cycle of scabbing over and then healing. (Anal and vaginal herpes can take longer to heal because of the moist environment in which they occur.) The first outbreak is always the worst. It can be treated with the antiviral medication acicyclovir (Zovirax) and its variations, famciclovir (Famvir) and valacyclovir (Valtrex). Taking this medication daily can reduce the severity of symptoms and frequency of recurrence. You can expect outbreaks to occur at unpredictable intervals, triggered by a cold or stress or friction. Recurrences usually get less severe and less frequent over time. If you have HIV or hepatitis-C, your immune system may be more susceptible to herpes outbreaks and so requires extra care and attention.

It’s possible to acquire the herpes virus without experiencing any symptoms. “How would you explain to someone what it means when a blood test returns positive for herpes simplex with no symptoms?” I asked Brett. He said, “It’s probably a mild or previously acquired infection, newly detected. If you discover you have it and you aren’t covered in lesions, rejoice, because it will continue to fade.” Another sex educator I know tells the people he counsels that a blood test that comes back positive for herpes most likely means that you’ve had sex with more than four people in your life.

How do you avoid passing genital herpes to a partner? That’s easy. You know when you have a herpes sore on your dick because it hurts and you don’t want anyone messing around with it in that condition anyway. Herpes is most infectious when there’s an open sore; once the skin has healed over, it’s safe to engage in sex with a partner. You may read online scary language about “viral shedding” that suggests that you’re infectious whether you have a visible sore or not. I don’t mean to be cavalier about this, but if it’s not measurable there’s no point in making yourself crazy about it, anymore than it makes sense to stay home all winter to avoid seasonal airborne colds.

How do you avoid contracting herpes from a partner? That’s also pretty easy. All sexually transmitted infections can be prevented by using condoms for insertive sex – there’s a reason that condoms used to be referred to as “prophylactics.” And let’s be honest, not everyone uses condoms for insertive sex. (Almost no one uses condoms for oral sex.) If you don’t, it’s common sense to take some other precautions, which can include having an honest and detailed conversation with your partners about possible infections (a conversation that does not limit itself to the offensive question “Are you clean?”) and/or visually examining the apparatus for suspicious bumps or rashes. I know it’s awkward to talk about these things, so try to make it fun and safe for yourself and others. For helpful suggestions on that front and a rational perspective on herpes from a woman’s point of view, check out the website of Ella Dawson, who has written numerous brave, informative, personal, mythbusting blog posts about many different aspects of herpes.

If you’re sexually active, it’s wise to get tested on a regular basis for sexually transmitted infections. If you know that you’re the kind of person who’s prone to hysteria and runs to the doctor to get tested after every sexual encounter that poses some risk, you might want to seek help and support from friends, peers, or professionals to scale back the behavior that causes you to freak out. Life is too short to let exaggerated fears get in the way of the pleasures of sex.